退变性脊柱侧凸的选择性手术治疗

目的评价选择性手术治疗退变性脊柱侧凸的临床疗效。方法2005年1月～2009年9月共手术治疗22例患者。记录所有患者术前、术后3个月及末次随访时的Oswestry功能评分；记录实施内固定治疗患者术前、术后3个月及末次随访时的侧凸Cobb角、腰椎前凸角以及融合时间。结果平均随访19个月（8—36个月）。椎管减压3例；椎管减压并内固定植骨融合术19例，其中长节段固定6例。Oswestry功能评分术前为39．25±10．47，术后3个月为13．85±7．73，末次随访时为17．95±6．18。实施内固定的患者侧凸Cobb角术前为21．05°±8．51°，术后3个月为12．13°±4．83°，末次随访时为14．03°±5．25°；腰椎前凸角术前为14．40°±14．72°，术后3个月为26．62°±11．48°，末次随访时为24．27°±11．03°；术后6个月，均达到骨性融合。上述各组术后3个月及末次随访的数据与术前比较差异均有统计学意义（P〈0．05）。结论退变性脊柱侧凸的治疗主要以缓解症状为目的，依据不同的临床及影像学表现制定个体化治定方案能够取得满意的临床疗效。

Selective surgical treatment for degenerative scoliosis

Objective To investigate clinical outcomes of selective surgical treatment for degenerative scoliosis. Methods From January 2001 to September 2009, 22 cases of degenerative scoliosis that underwent surgical treatment were analyzed retrospectively. Oswestry scores were observed in all the patients, and scoliosis Cobb's angles, lumbar lordosis angles and fusion time were observed in the internal fixation patients. All the data were recorded preoperatively, 3 month postoperatively and at the last follow-up. Results The average follow-up period was 19 months (8-36 months). Three cases underwent single decompression and 19 cases had decompression and posterior internal fixation, including 6 cases of long segment fixation. Oswestry scores were 39.25±10.47 preoperatively, 13.85±7.73 at 3 months postoperative, and 17.95±6.18 at the last follow-up. Scoliosis Cobb's angles of patients that underwent internal fixation were 21.05°±8.51°preoperatively, 12.13°±4.83° at 3 months postoperative, and 14.03°±5.25° at the last follow-up; lumbar lordosis angles were 14.40°±14.72° preoperatively, 26.62°±11.48°at 3 months postoperative, and 24.27°±11.03° at the last follow-up; fusion was observed at 6 months after internal fixation. There were statistic difference between 3 months postoperative data and preoperative data (P<0.05). There were statistic difference between data of the last follow-up and preoperative data (P<0.05). Conclusion The treatment for degenerative scoliosis should be focused on relief of clinical symptoms. Selective surgical treatment according to clinical and radiological characteristics can achieve satisfied clinical outcomes.